Teen pregnancy rate drop misses rural areas

Birth rate even higher among South Dakota's tribal teens

Mar. 10, 2013

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Counting the cost

An analysis by the National Campaign to Prevent Teen and Unplanned Pregnancy shows that teen childbearing in South Dakota cost taxpayers at least $23 million in 2008. Among other things, the organization found that: ■ 57 percent of those costs were federal costs; 43 percent were state and local costs. ■ Taxpayer costs associated with children born to teen mothers in South Dakota in 2008 included $6 million for Medicaid and Children’s Health Insurance Program and $6 million for child welfare. ■ Between 1991 and 2008, there have been 21,122 teen births in South Dakota, costing taxpayers a total of $400 million during that period. ■ The teen birth rate in South Dakota declined 16 percent between 1991 and 2008, resulting in taxpayer savings of $6 million alone in 2008 over costs it would have incurred had the rates not fallen.

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A steady decline in teen birth rates across the country the past two decades has been less pronounced in rural communities, a fact with social and economic implications for South Dakota.

In 2010, the birth rate for teens ages 15 to 19 in rural counties — those with a population of 50,000 or less — was 43 per 1,000, almost one-third higher than the 33 per 1,000 in metropolitan counties, according to a recent report by the National Campaign to Prevent Teen and Unplanned Pregnancy.

That’s a significant difference in a state such as South Dakota, where 64 of 66 counties fall into the rural category, and where teen births among Native Americans are as much as 4.2 times higher than their white counterparts.

“Most of the American Indian teens in our state are from rural areas,” said DenYelle Kenyon, a scientist with Sanford Research who is working on a project to address teen pregnancy through education. “Rural teens by definition are in underserved communities and are more likely to be in poverty, as well as have less access to health care services.”

The breakdown between rural and urban teen birth rates in the state was not available as of late Friday from the South Dakota Health Department. But the National Campaign to Prevent Teen and Unplanned Pregnancy estimates that the 21,122 teen births in South Dakota between 1991 and 2008 have cost taxpayers at least $400 million.

In 2008, that cost was at least $23 million, including $6 million for Medicaid and the Children’s Health Insurance Program, and $6 million for child welfare.

Kenyon said investing in prevention and awareness makes economic sense for the state but also would “support teen parents and their children to help curb some of those obstacles that are associated with teen pregnancy; for example, helping moms finish school.”

There are several efforts in place now to address the issue, particularly among tribal youths. Sanford Research is a main partner in a grant funded under the Centers of Excellence through the National Institutes of Health. Working with Urban Indian Health in Sioux Falls, and with public and tribal schools in the Sisseton area, the Sanford project is developing a health and sex education curriculum that potentially could be used across the state.

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“What we’re finding, depending on the school, is that they’re all teaching different things and have different curriculum in place,” Kenyon said. “There are different youth programs and curriculum that they’re asked to do, including bullying and drug abuse and alcohol use. Teen pregnancy isn’t one of the top concerns.”

Kenyon understands that the issue of sex education can be a delicate one to address in schools.

“It’s a little more sensitive to navigate as far as what makes sense for communities and what is acceptable for communities and what they want,” she said. “We’re just trying to navigate that and make sure it fits with what parents and teachers and community members want for their kids.”

Tribal efforts

Missy Huff, program coordinator for the Teen Pregnancy Prevention project in Sisseton, said they have just finished phase one of their work, interviewing school and medical personnel in the area and holding focus group discussions with young people and older adults in the community.

Now with the data they’ve collected, they hope to engage writers to develop curriculum that can be used in Sisseton area schools this fall.

“We want to teach young people that they have options,” Huff said. “They do have a choice in life in all areas. And not just as far as unplanned pregnancies, but as far as drug use and alcohol use and other life choices.”

The Great Plains Tribal Chairmen’s Health Board is taking a similar tack at the middle school in Kyle on the Pine Ridge Reservation, said Maylynn Warne, the board’s director of health promotion and disease prevention.

Using grant dollars from the Tribal Personal Responsibility Education Program, they want to reduce sexually transmitted diseases and teen pregnancies and impart more knowledge to youth so they can make better health-related decisions.

“The issues on the reservation are complex,” Warne said. “I think along with the socioeconomic issues there that affect teen pregnancy, there is also a lack of education, a lack of resources, a lack of access to condoms and birth control, and not having a place where people feel comfortable accessing those things.”

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She is hoping that an evidence-based program that is culturally tailored to tribal students and brought to them in the classroom by Indian Health Service staff can bring about change. A drop in sexually transmitted diseases and teen pregnancy rates would indicate their programs are working, Warne and Kenyon said. But at the very least, they intend to test students before they begin the new curriculum, then test them again afterward, to measure how well they are learning and retaining the knowledge.

There always will be challenges. For Warne, sequestration cuts enacted by Congress threaten the viability of her work.

“The communities we are in are really happy with our programs,” she said. “But after this year, our funding may be at jeopardy, which could really impact the youth in these communities. If we can just get through the next few years, our long-term hope is that this curriculum ... just becomes part of normal school curriculum.”

That is Kenyon’s hope as well, and not just in those schools where the project is being developed now but potentially throughout the state. Of course, she understands that education alone can’t solve community issues such as teen pregnancy.

“We’re always going to face that in the rural areas,” she said.

“You have to think about other factors ... access to health care services, or that teen pregnancy is a repeating cycle or pattern of teen parenting. So yeah, even if we create a wonderful curriculum that affects their decision-making ability and healthy outcomes, poverty always has a very strong influence, unfortunately.”